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A Tough Pill to Swallow

Dr. Dhairya Shrivastava

By Dr. Dhairya Shrivastava, MBBS, MBA

Dr Dhairya Shrivastava discusses the preparedness of the Indian government against rising Omicron variant COVID-19 cases

2021 is on its way out, and in my last and final blog, I will do some reflection as the year draws to a close.  

 

The last blog focuses on the current state of preparedness of the Indian government in the face of an imminent wave of Omicron variant cases. I will tie this piece with the learnings of the past blogs as well as conclude my blogging journey with HPHR. 

The Omicron variant

A new call for action has been sounded round the world, as nations are uniting to suppress another surge in COVID-19 cases, driven by the newer Omicron variant.

 

On 27th of December 2021, the International Day of Epidemic Preparedness, the United Nations Secretary-General Antonio Guterres alerted the global community that infectious diseases pose “a clear and present danger to every country”. He also said that the devastation of the COVID-19 pandemic portrayed that the world has “failed to learn from health emergencies”.

 

The same sentiment was echoed by the 2021 Global Health Security (GHS) Index, which also affirmed that countries across all income levels, including India, are unprepared to meet future epidemic and pandemic threats. This assessment was done basis of countries’ performance across 6 categories: prevention, detection and reporting, rapid response, health system, compliance with international norms, and risk environment. 

Gearing up…

As of 31 December 2021, at least 1270 cases of the Omicron variant have been reported across 19 states and union territories across India. In response, social distancing measures and night curfews have been imposed by many state governments, like Assam, Delhi, Gujarat, Haryana, Karnataka, Madhya Pradesh and Uttar Pradesh. Gymnasiums and restaurants have been directed to function at 50% capacity. Many state governments have started allotting additional budgets and oxygen beds in anticipation. 

 

In the National Capital Region of New Delhi, ‘Yellow alert’ has been raised. All these measures are under the gambit of the “Corona Graded Response Action Plan” rolled out by the Delhi state government in July 2021. The alerts — yellow, amber, orange, and red — are sequentially graded, and will be issued based on positivity rate, new positive cases of COVID-19, and number of occupied oxygen beds in Delhi. Experts and model developers from the Indian Institute of Technology, Kanpur have predicted an Omicron peak in February 2022, and a dip in March 2022. 

 

The Central Drugs and Standard Control Organization has granted permissions to 6 COVID-19 vaccines to be manufactured in the country. Out of the six, three of them — Covishield, Covaxin and Sputnik V — are presently being used in the national vaccination program. On December 25, 2021, Prime Minister Modi gave an important announcement regarding the vaccination program. India would start vaccinating children of 15 to 18 years from January 3, 2022. Additionally, from January 10, 2022, booster doses for healthcare workers and precautionary doses for those above 60 with co-morbidities will be rolled out.

 

The central government has also issued a special advisory to state governments to “activate war rooms” to fight the omicron wave when the positivity rate breaches the critical 10% mark and the occupancy rate in hospitals crosses 40%. Travel restrictions have been put in place and the “Test, Track, and Treat” mantra is being diligently followed by the agencies. 

A vulnerability index for the management of and response to the COVID-19 epidemic in India; Source: The Lancet

Déjà Vu…

The current responses mirror the ingredients and recipe which led to the disaster of the second peak of the Delta variant of COVID -19 pandemic. Social distancing measures were instated, seating capacities were reduced, and travel advisories were doled out.

 

However, legislations and advisories only have effect if they are enforced and the guilty are held accountable. As is the case this year, the stringency of orders at the ground-level is lacking. Moreover, super-spreader events like election rallies and mass gatherings were somehow ignored. In 2022, at least five key states of India have state elections and election rallies are in full swing. Another area of concern is the slow rate of genomic sequencing of COVID-19 samples. As compared to other nations — Denmark (46%), Switzerland (9%), Australia (21%) — India has been lagging behind at just 0.2% according to a recent report, which is way below other nations. 

 

Some reports and the fourth seroprevalence survey suggest that India may not see a tidal wave of cases, as the majority of the population has antibodies against the Delta variant and about four-fifths of adults have been partially vaccinated. This, however, should not make us hopeful, because even if the quantum of cases does not rise, the available infrastructure is inadequate for handling another crisis. This failure was portrayed by the reports surrounding the dengue virus outbreak in the monsoon months.  

Superficial interventions…

Despite the havoc wreaked by the second wave of Delta variants, government spending on healthcare has marginally increased to 1.3% of the entire GDP for the year ending in 2022. This is way behind the promised 2.5% allocation.

 

In my second blog I talked about Ayushman Bharat, India’s universal health insurance programe. Several reports suggested that there were many disparities in the roll out of the scheme across states. Many eligible people were unable to avail benefits during the COVID crises. In the current strategies, no specific mention is being made about bolstering the grassroot level ASHA workers, who were the infantry in the government’s arsenal to fight the second wave. There is a similar absence of narrative surrounding the biomedical and sanitation workers. Not to mention, apart from the reactionary measures to make workplace environments safe for healthcare workers, no systemic interventions have been carried out.

 

Presently, the arsenal in government’s strategy is the mega-vaccination drive, but it still needs to earn the confidence of many. Rural areas are still hesitant to get the jabs and breakthrough infections are plummeting the already dwindling trust. With no visible fundamental changes in healthcare policy and pandemic mitigation strategies, healthcare workers and the population are anxiously witnessing the surge of Omicron cases. 

Concluding Reflections

As the year draws to a close, I will wish all the readers could get a glimpse into the complicated state of health affairs of India. The critique in my blogs is not to undermine the valiant efforts of the concerned authorities during these difficult times. I just want to draw attention to ongoing plaguing issues and their embedded root causes.

 

No strategy is foolproof, but the deficiencies in response to the Omicron surge are very unsettling. I would not like to solely blame the governments, states or central, for this; the overall population has not adhered to the norms and restrictions put in place, flouting the social distancing and mask rules and not abiding by COVID appropriate behaviour. The convoluted situation makes it A Tough Pill To Swallow.

 

I bid adieu to the year 2021 and looking back, wish for people to have learnt from their past mistakes, and as cliché as it may sound, make resolutions for a better 2022. 

 

To all the readers and their friends and family, I wish a very happy and a healthy new year!

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